Having Children After Transplant
Most, but not all, patients will become infertile after transplant. If you are having a reduced intensity transplant (also called a mini or nonmyeloablative transplant) you are less likely to become infertile.
Fortunately, there are options available to people who wish to have children after a transplant.
Options for Males
Most males can bank their sperm before transplant. Even if you don't think you want children, sperm banking is worth considering. You may change your mind later in life, and having sperm banked preserves that option.
Discussing sperm banking with an adolescent who needs a transplant can be challenging and emotionally upsetting for the young man. Consider consulting the hospital social worker or a therapist about how best to approach this delicate matter with your child.
If you do not bank your sperm prior to transplant, a procedure called testicular sperm retrieval may be an option after transplant. Even if there is no sperm in the ejaculate, there may be viable sperm in the testes which can be extracted and used to fertilize a woman's egg and create an embryo. There have been two reports of stem cell transplant survivors fathering children after transplant using this technique.
Testicular sperm retrieval may also be considered prior to transplant if there is no sperm in the ejaculate due to prior treatment. This may not be an option for patients who need to proceed to transplant quickly.
Options for Females
For women, it may be possible to collect eggs prior to transplant, fertilize them with male sperm to create embryos, and then freeze the embryos for later use. This procedure requires several weeks and may not be an option for patients who need to proceed quickly to transplant.
After transplant, a woman may be able to become pregnant by having the embryos implanted in her womb. This procedure, called in-vitro fertilization, is not always successful but several transplant survivors have conceived children by this method
It is also possible to collect and freeze a woman's eggs without fertilizing them with male sperm. However, unfertilized eggs are less likely to survive the freezing and thawing process than fertilized eggs.
Another experimental option for women is freezing ovarian tissue. Ovarian tissue is removed during a short, outpatient surgical procedure and then frozen. The tissue can later be implanted into a woman's ovary where it may produce eggs.
Live Strong/Fertile Hope offers a wealth of information about parenthood options after transplant, referrals to fertility clinics in the US, and questions to ask fertility and adoption agencies. Their Sharing Hope program provides financial aid to men who wish to bank sperm prior to cancer therapy, and financial aid to women for egg or embryo freezing.
The Society for Assisted Reproductive Technology offers data on success rates at fertility clincis, as well as patient fact sheets helpful as you consider our options for having children after transplant.